Surgical clip applier and method of assembly

ABSTRACT

Surgical clip appliers are provided including a channel assembly extending distally from a housing; a clip carrier disposed within the channel assembly and defining a channel and a plurality of windows therein; a plurality of clips slidably disposed within the channel of the clip carrier; a wedge plate reciprocally disposed within the channel assembly, the wedge plate being operatively connected to the handles and including a plurality of apertures formed along a length thereof; and a clip follower slidably disposed within the channel of the clip carrier and disposed proximally of the plurality of clips, the clip follower being configured and adapted for selective engagement with the windows of the clip carrier and the apertures of the wedge plate. The clip follower is configured and adapted to urge the plurality of clips, in a distal direction relative to the clip carrier, upon reciprocal movement of the wedge plate.

CROSS SECTION TO RELATED APPLICATION

The present application claims the benefit of priority to U.S.Provisional Application Ser. No. 61/091,467, filed on Aug. 25, 2008, theentire content of which is incorporated herein by reference.

BACKGROUND

1. Technical Field

The present application relates to surgical instruments and theirmethods of assembly, and more particularly, to surgical clip appliershaving a plurality of clips for applying the clips to body tissues andvessels during surgical procedures and their methods of assembly.

2. Discussion of Related Art

Surgical clip appliers are known in the art and have increased inpopularity among surgeons by offering an alternative to conventionalsuturing of body tissues and vessels. Typical instruments are disclosedin U.S. Pat. No. 5,030,226 to Green et al. and U.S. Pat. No. 5,431,668to Burbank III et al. These instruments generally provide a plurality ofclips which are stored in the instrument and which are fed sequentiallyto the jaw mechanism at the distal end of the instrument upon openingand closing of the handles at the proximal end of the instrument. As thehandles are closed, the jaws close to deform a clip positioned betweenthe jaw members, and as the jaws are opened to release the deformedclip, a new clip is fed from the series to a position between the jaws.This process is repeated until all the clips in the series of clips havebeen used.

Surgical clip appliers are typically available in a variety of sizesand/or scales ranging from relatively small, relatively medium torelatively large. Generally, each particular size of surgical clipappliers includes different components. As such, the method ofassembling the various sized surgical clip appliers differs from onesize to another.

As a consequence, the technicians must be taught different routines andprocedures for assembling the various sized surgical clip appliers. As aresult, errors in the assembling of the various sized surgical clipappliers may occur on an elevated level as the technicians' mistake theassembly procedure of one sized surgical clip applier for the assemblyprocedure of another sized surgical clip applier.

The need therefore exists for a family of different sized instrumentsfor applying surgical clips which may be assembled in the same mannerfrom one size to another size.

Also, a need exists for a uniform method of assembling each of thedifferent sized instruments in order to improve the efficiency ofproduction.

SUMMARY

The present application relates to surgical clip appliers having aplurality of clips for applying the clips to body tissues and vesselsduring surgical procedures and their methods of assembly.

According to an aspect of the present disclosure, a surgical clipapplier is provided including a housing; at least one handle pivotablyconnected to the housing; a channel assembly extending from the housing;a clip carrier disposed within said channel assembly and defining achannel and a plurality of windows therein; a plurality of clipsslidably disposed within said channel of said clip carrier; a wedgeplate reciprocally disposed within said channel assembly, said wedgeplate being operatively connected to said handles and including aplurality of apertures formed along a length thereof; and a clipfollower slidably disposed within said channel of said clip carrier at alocation proximal of said plurality of clips, said clip follower beingconfigured and adapted for selective engagement with said windows ofsaid clip carrier and said apertures of said wedge plate. The clipfollower is configured and adapted to distally urge said plurality ofclips relative to said clip carrier upon reciprocal movement of saidwedge plate.

The clip follower may be configured to engage the wedge plate and movedistally upon distal translation of the wedge plate, and may beconfigured to engage the clip carrier and stop proximal movement thereofupon proximal translation of the wedge plate.

The clip applier may further include a jaw assembly including a pair ofjaws extending from an end of said channel assembly, opposite saidhousing. The jaw assembly may be adapted to accommodate a clip thereinand may be operable to effect formation of a clip in response tomovement of said handles.

The clip applier may further include a clip pusher bar reciprocallypositioned within at least one of said housing and said channelassembly. The pusher bar may have a first end operatively connected tosaid at least one handle and a second end defining a pusher. The pusherbar may be movable towards said jaws as said at least one handle ismoved in a first direction by an initial amount in order to move adistal-most clip between said jaws. The pusher bar may be configured andadapted to move towards said housing as said at least one handle ismoved an additional amount in said first direction to move said pusherbehind a distal-most clip in said plurality of clips.

The clip applier may further include a motion multiplier systemconfigured to distally move the pusher bar by an incremental amount uponan initial actuation of the handles, and configured to proximally movethe pusher bar and the wedge plate subsequent to the initial actuationof the handles.

The clip applier may still further include a drive channel translatablyslidably disposed within at least one of said housing and said channelassembly. The drive channel may have a first end operatively connectedto at least one of said handles and a second end configured anddimensioned to selectively engage said pair of jaws to effectuateclosure of said pair of jaws. The drive channel may be moved towardssaid jaw assembly as said handles are actuated in a first direction tomove said second end thereof against said jaws to close said jaws. Thedrive channel may be moved away from said jaws as said handles are movedin a second direction to move said second end thereof away from saidjaws to allow said jaws to open.

The clip applier may further include a pivot arm operatively connectedto said wedge plate and said drive channel. Rotation of said pivot arm,during distal movement of said drive channel, may result in proximalmovement of said wedge plate.

The clip applier may further include a motion multiplier system having abell crank gear pivotally supported in the housing and pivotallyconnected to the pusher bar; an accelerator rack slidably supported inthe housing and operatively joined to the bell crank gear; and a biasingmember interconnecting the drive channel and the accelerator rack. Adistal translation of the drive channel may cause distal translation ofthe accelerator rack via the biasing member. Distal translation of theaccelerator rack may cause a first rotation of the bell crank gear anddistal translation of the pusher bar.

The bell crank gear may include an arm extending radially therefrom andan elongate slot formed in the arm, wherein the elongate slot slidablyreceives a boss operatively associated with the pusher bar.

The clip applier may further include a motion reversing mechanismoperatively connected to said drive channel and said wedge plate andselectively engageable with said pusher bar. Rotation of said motionreversing mechanism, during said distal translation of said drivechannel, may result in proximal movement of said wedge plate and saidpusher bar.

The clip applier may further comprise a ratchet mechanism including arack, having a plurality of ratchet teeth, associated with said drivechannel; and a pawl, having at least one tooth, disposed at a locationto selectively engage said rack. The pawl may be biased into engagementwith said rack. As said drive channel is longitudinally reciprocated,said plurality of teeth may be passed over said pawl. The pawl mayprevent inadvertent return of said drive channel before full actuationof said at least one handle.

The clip applier may further include a lockout disposed in a distal endof said channel assembly. The lockout may be actuated by said clipfollower when a last clip is expelled from said clip applier. Thelockout may be urged by said clip follower to extend across a path ofsaid drive channel, thereby preventing said drive channel from movingdistally.

The clip applier may further include a counter mechanism supported in atleast one of said housing and said channel assembly. The countermechanism may be configured and adapted to display a change in said clipapplier upon each actuation of said handles.

The drive channel may be configured and dimensioned to at leastpartially surround said jaws and said wedge plate. The drive channel mayinclude a strap extending across a distal end thereof for maintainingsaid jaws and said wedge plate within said drive channel.

According to another aspect of the present disclosure, a surgical clipapplier is provided including a housing; at least one handle pivotablyconnected to opposite sides of the housing; a channel assembly fixed toand extending from the housing; a pair of jaws supported on andextending from a distal end of the channel assembly; a clip carrierdisposed within said channel assembly and defining a channel; aplurality of clips slidably disposed within said channel of said clipcarrier; a clip follower slidably disposed within said channel of saidclip carrier at a location proximal of said plurality of clips; a drivechannel translatably disposed within at least one of said housing andsaid channel assembly, said drive channel having a first end operativelyconnected to at least one of said handles and a second end configuredand dimensioned to selectively engage said pair of jaws to effectuateclosure thereof; a pusher bar translatably disposed within at least oneof said housing and said channel assembly, said pusher bar beingconnected to said drive channel via a motion multiplier system, a distalend of said pusher bar being configured to engage a distal-most clip ofthe plurality of clips; a wedge plate reciprocally disposed within atleast one of said housing and said channel assembly, wherein a distalend of said wedge plate is selectively insertable between said pair ofjaws; and a motion reversing mechanism including a first end connectedto said drive channel, and a second end connected to said wedge plateand engageable by said pusher bar. In use, distal translation of saiddrive channel causes said pusher bar to translate distally via saidmotion multiplier system; and distal translation of said drive channelcauses said pusher bar and said wedge plate to translate proximally, viasaid motion reversing mechanism, following a dwell period.

The wedge plate may define a plurality of apertures formed along alength thereof. The clip carrier may define a plurality of windowsformed along a length thereof. The clip follower may be configured andadapted for selective engagement with said windows of said clip carrierand said apertures of said wedge plate. The clip follower may beconfigured and adapted to distally incrementally urge said plurality ofclips relative to said clip carrier upon a distal advancement of saidwedge plate.

The clip applier may further include an indicator configured to createat least one of an audible indication and a tactile indication upon atleast one of a loading of a clip into said pair of jaws and a formationof a clip by said pair of jaws.

The motion multiplier system may include an accelerator rack having aseries of teeth and the bell crank gear may include a series of teethengaged with the teeth of the accelerator rack. Axial translation of theaccelerator rack may result in rotation of the bell crank gear and axialtranslation of the pusher bar.

The accelerator rack may be connected to the drive channel via a biasingmember.

According to a further aspect of the present disclosure, a surgical clipapplier mechanism operable to deliver at least relatively small, mediumand large surgical clips, the surgical clip applier mechanism isprovided and includes a drive channel capable of translatable movement;a pair of jaws engageable by a distal end of the drive channel, whereinthe pair of jaws are approximated upon distal translation of the drivechannel; a wedge plate capable of reciprocal translation relative to thedrive channel, wherein a distal end of the wedge plate is selectivelypositionable between the pair of jaws, the wedge plate defining aplurality of apertures formed along a length thereof; a clip carrierfixedly located with respect to the drive channel, the clip carrierdefining a channel and a plurality of windows formed along a lengththereof; a plurality of clips slidably disposed within said channel ofsaid clip carrier; a clip follower slidably disposed within said channelof said clip carrier at a location proximal of said plurality of clips;a pusher bar capable of reciprocal translation relative to the drivechannel, wherein a distal end of the pusher bar is configured forengagement with a distal-most clip of the plurality of clips; a motionmultiplier system including bell crank gear and an accelerator rack, theaccelerator rack being coupled to the drive channel via a biasingmember, the bell crank gear being coupled to the accelerator rack viacomplementary gear teeth, and the bell crank gear being coupled to thepusher bar, wherein distal translation of the drive channel causes theaccelerator rack to translate distally, causing the bell crank gear torotate, causing the pusher bar to translate distally; and a pivot armincluding a first end connected to the drive channel, and a second endconnected to the wedge plate and engageable by the pusher bar. In use,distal translation of the drive channel causes the first end of thepivot arm to translate distally, causing the second end of the pivot armto translate in a proximal direction, thus causing the wedge plate totranslate in a proximal direction; and distal translation of the pusherbar is stopped upon contact of the pusher bar with the second end of thepivot arm.

The further translation of the second end of the pivot arm in theproximal direction may cause the pusher bar to translate in a proximaldirection. Actuation of the pivot arm by the drive channel may occurafter a dwell period.

BRIEF DESCRIPTION OF THE DRAWINGS

The present clip applier will be more fully appreciated as the samebecomes better understood from the following detailed description whenconsidered in connection with the following drawings, in which:

FIG. 1 is a perspective view of a surgical clip applier according to anembodiment of the present disclosure;

FIG. 1A is a rear, perspective view of the surgical clip applier of FIG.1, shown with a shipping wedge in position;

FIG. 1B is a cross-sectional view as taken through 1B-1B of FIG. 1A;

FIG. 1C is a cross-sectional view as taken through 1C-1C of FIG. 1A;

FIG. 2 is a top, plan view of the surgical clip applier of FIG. 1;

FIG. 3 is a side, elevational view of the surgical clip applier of FIGS.1 and 2;

FIG. 4 is an exploded perspective view of the surgical clip applier ofFIGS. 1-3;

FIG. 4A is an exploded perspective view of a bell crank gear andaccelerator rack assembly of the surgical clip applier of FIGS. 1-4;

FIG. 4B is a perspective view of the accelerator rack of the surgicalclip applier of FIGS. 1-4;

FIG. 4C is a perspective view of the bell crank gear of the surgicalclip applier of FIGS. 1-4;

FIG. 4D is a top, perspective view of a pivot arm of the surgical clipapplier of FIGS. 1-4;

FIG. 4E is a bottom, perspective view of the pivot arm of FIG. 4D;

FIG. 4F is a top, perspective view of a clip follower of the surgicalclip applier of FIGS. 1-4;

FIG. 4G is a perspective view of an audible/tactile indicator of thesurgical clip applier of FIGS. 1-4;

FIG. 4H is a perspective view of a rack member of the surgical clipapplier of FIGS. 1-4;

FIG. 5 is a longitudinal cross-sectional view of the surgical clipapplier of FIGS. 1-4, illustrating the surgical clip applier in anunactuated condition;

FIG. 6 is an enlarged view of the indicated area of detail of FIG. 5;

FIG. 7 is an enlarged view of the indicated area of detail of FIG. 5;

FIG. 8 is an enlarged view of the indicated area of detail of FIG. 5;

FIG. 9 is a cross-sectional view of the surgical clip applier of FIGS.1-4, as taken through 9-9 of FIG. 8;

FIG. 10 is a perspective view of the surgical clip applier of FIGS. 1-4,illustrated with an upper housing half removed therefrom;

FIG. 11 is an enlarged view of the surgical clip applier of FIGS. 1-4,as shown in FIG. 10;

FIG. 12 is a top, perspective view of a distal end of a channel assemblyof the surgical clip applier of FIGS. 1-4, with a cover removedtherefrom;

FIG. 13 is a top, perspective view of the surgical clip applier of FIGS.1-4, illustrated with the upper housing half and a pusher bar removedtherefrom;

FIG. 14 is a top, perspective view of a distal end of the channelassembly of FIG. 12, with the cover and the pusher bar removedtherefrom;

FIG. 15 is a top, perspective view of a distal end of the channelassembly of FIG. 12, with the cover, the pusher bar and a clip carrierremoved therefrom;

FIG. 16 is a top, perspective view of a distal end of the channelassembly of FIG. 12, with the cover, the pusher bar, the clip carrier,the surgical clips and the clip follower removed therefrom;

FIG. 17 is an enlarged view of the indicated area of detail of FIG. 16;

FIG. 18 is a top, perspective view of the surgical clip applier of FIGS.1-4, illustrated with the upper housing half, the pusher bar and a wedgeplate removed therefrom;

FIG. 19 is a top, perspective view of a distal end of the channelassembly of FIG. 12, with the cover, the pusher bar, the clip carrier,the surgical clips, the clip follower and the wedge plate removedtherefrom;

FIG. 20 is a top, perspective view of the surgical clip applier of FIGS.1-4, illustrated with the upper housing half, the pusher bar, the wedgeplate and a drive channel removed therefrom;

FIG. 21 is a bottom, perspective view of the surgical clip applier ofFIGS. 1-4, illustrated with a lower housing half, the drive channel andthe wedge plate removed therefrom;

FIG. 22 is a top, plan view of the surgical clip applier of FIGS. 1-4,with the upper housing half removed therefrom and shown in anun-actuated condition;

FIG. 23 is an enlarged view of the indicated area of detail of FIG. 22;

FIG. 24 is an enlarged view of the indicated area of detail of FIG. 22;

FIG. 25 is a top, plan view of the surgical clip applier of FIGS. 1-4,with the upper housing half removed therefrom and shown during aninitial actuation thereof;

FIG. 26 is an enlarged view of the indicated area of detail of FIG. 25;

FIG. 27 is an enlarged view of the indicated area of detail of FIG. 27;

FIG. 28 is an enlarged, longitudinal cross-sectional view of the distalend of the channel assembly during the initial actuation of the surgicalclip applier;

FIG. 29 is a cross-sectional view as taken through 29-29 of FIG. 27;

FIG. 30 is an enlarged, longitudinal cross-sectional view of the distalend of the channel assembly during a further initial actuation of thesurgical clip applier;

FIG. 31 is an enlarged view of illustrating the operation of a ratchetassembly and accelerator rack of the surgical clip applier of FIGS. 1-4;

FIGS. 32 and 33 are enlarged view illustrating the operation of anaudible/tactile indicator during the respective initial and furtheractuation of the surgical clip applier of FIGS. 1-4;

FIG. 34 is a top, plan view of the surgical clip applier of FIGS. 1-4,with the upper housing half removed therefrom and shown during a finalactuation of the surgical clip applier;

FIG. 35 is an enlarged view of the indicated area of detail of FIG. 34;

FIG. 36 is an enlarged, cross-sectional view illustrating an actuationof a counter mechanism of the surgical clip applier of FIGS. 1-4;

FIG. 37 is an enlarged view of a ratchet mechanism shown during thefinal actuation of the surgical clip applier of FIGS. 1-4;

FIG. 38 is an enlarged, cross-sectional view of the channel assemblyillustrating the clip follower during the final actuation of thesurgical clip applier of FIGS. 1-4;

FIGS. 39 and 40 are enlarged perspective view, illustrating the distalend of the channel assembly during the final actuation of the surgicalclip applier of FIGS. 1-4;

FIG. 41 is a top, plan view of the surgical clip applier of FIGS. 1-4,with the upper housing half removed therefrom and shown at a finalcondition after an actuation of the surgical clip applier;

FIG. 42 is an enlarged view of the indicated area of detail of FIG. 41;

FIG. 43 is an enlarged view illustrating the position of theaudible/tactile indicator following an actuation of the surgical clipapplier of FIGS. 1-4;

FIG. 44 is a top, plan view of the jaw assembly illustrating theposition of the jaw assembly following an actuation of the surgical clipapplier of FIGS. 1-4;

FIG. 45 is a perspective view of a body vessel including a clip of thesurgical clip applier, shown applied thereto;

FIG. 46 is an enlarged view of the indicated areas of detail of FIGS. 34and 41, illustrating the operation of the pivot arm during an opening orrelease of the surgical clip applier following a complete actuationthereof;

FIG. 47 is an enlarged view of the ratchet mechanism shown during theopening or release of the surgical clip applier of FIGS. 1-4;

FIG. 48 is an enlarged view illustrating the operation of theaudible/tactile indicator during the opening or release of the surgicalclip applier of FIGS. 1-4;

FIGS. 49 and 50 are longitudinal, cross-sectional views of the channelassembly illustrating the movement of the clip follower during theopening or release of the surgical clip applier of FIGS. 1-4;

FIGS. 51 and 52 are longitudinal, cross-sectional views of the distalend of the channel assembly illustrating the movement of the pusher barand wedge plate during the opening or release of the surgical clipapplier of FIGS. 1-4;

FIG. 53 is a longitudinal, cross-sectional view of the distal end of thechannel assembly illustrating the surgical clip applier of FIGS. 1-4 ina locked-out condition following firing of the last surgical cliptherefrom;

FIG. 54 is a perspective view of a drive channel including an integralratchet rack according to an alternate embodiment of the presentdisclosure;

FIGS. 55-57 are enlarged schematic illustrations of the operation of aratchet mechanism of the surgical clip applier including the drivechannel of FIG. 54;

FIG. 58 is an exploded perspective view of a surgical clip applieraccording to another embodiment of the present disclosure;

FIG. 59 is a perspective view of an audible/tactile indicator of thesurgical clip applier of FIG. 58;

FIG. 60 is a perspective view of an accelerator rack of the surgicalclip applier of FIG. 58;

FIG. 61 is a perspective view of a pinot arm of the surgical clipapplier of FIG. 58;

FIG. 62 is a perspective view of a first arm link for the surgical clipapplier of FIG. 58;

FIG. 63 is a perspective view of a second arm link for the surgical clipapplier of FIG. 58;

FIGS. 64-66 are perspective views of the sequential operation of theaudible/tactile indicator and accelerator rack of the surgical clipapplier of FIG. 58, during a complete squeezing of the handles thereof;

FIGS. 67-69 are perspective views of the sequential operation of thepivot arm and the arm link of the surgical clip applier of FIG. 58,during a complete squeezing of the handles thereof;

FIG. 70 is an exploded perspective view of a surgical clip applieraccording to another embodiment of the present disclosure;

FIG. 71 is an enlarged perspective view of a gear member of the surgicalclip applier of FIG. 70;

FIG. 72 is an enlarged perspective view of a drive channel gear rack ofthe surgical clip applier of FIG. 70;

FIG. 73 is an enlarged perspective view of a pusher gear rack of thesurgical clip applier of FIG. 70;

FIG. 74 is an enlarged perspective view of a proximal end of a pusherbar of the surgical clip applier of FIG. 70;

FIG. 75 is a perspective view of a handle assembly of the surgical clipapplier of FIG. 70, illustrated with a housing half-section removedtherefrom and shown in an initial un-squeezed condition;

FIG. 76 is a perspective view of the handle assembly of FIG. 75 shownwith the pusher bar also removed therefrom;

FIG. 77 is a plan view of the handle assembly of FIG. 76;

FIG. 78 is a perspective view of the handle assembly as illustrated inFIG. 75, shown during an initial squeezing of the triggers;

FIG. 79 is a plan view of the handle assembly of FIG. 78;

FIG. 80 is a perspective view of the handle assembly of the surgicalclip applier of FIG. 70, illustrated with a housing half-section removedtherefrom and shown during a further squeezing of the triggers;

FIG. 81 is a perspective view of the handle assembly of FIG. 80 shownwith the pusher bar also removed therefrom;

FIG. 82 is a plan view of the handle assembly of FIG. 81;

FIG. 83 is a perspective view of the handle assembly of the surgicalclip applier of FIG. 70, illustrated with the housing half-sectionremoved therefrom and shown during still a further squeezing of thetriggers;

FIG. 84 is a plan view of the handle assembly of FIG. 83;

FIG. 85 is a perspective view of the handle assembly of the surgicalclip applier of FIG. 70, illustrated with the housing half-sectionremoved therefrom and shown during still a final squeezing of thetriggers;

FIG. 86 is a plan view of the handle assembly of FIG. 85; and

FIGS. 87-110 illustrate a method of assembling the surgical clip applierof FIGS. 1-57.

DETAILED DESCRIPTION OF EMBODIMENTS

Embodiments of surgical clip appliers in accordance with the presentdisclosure will now be described in detail with reference to the drawingfigures wherein like reference numerals identify similar or identicalstructural elements. As shown in the drawings and described throughoutthe following description, as is traditional when referring to relativepositioning on a surgical instrument, the term “proximal” refers to theend of the apparatus which is closer to the user and the term “distal”refers to the end of the apparatus which is further away from the user.

Referring now to FIGS. 1-5, a surgical clip applier in accordance withan embodiment of the present disclosure is generally designated as 100.Surgical clip applier 100 generally includes a handle assembly 102including a housing 104 having an upper housing half 104 a and lowerhousing half 104 b. Handle assembly 102 further includes a pair ofhandles 106 pivotably secured to housing 104 and extending outwardlytherefrom. A channel assembly 108 is fixedly secured to housing 104 andextends outwardly therefrom, terminating in a jaw assembly 110.

As seen in FIGS. 1-4, housing halves 104 a and 104 b of clip applier 100fit together by snap fit engagement with one another. Housing 104defines a window 104 c formed in lower housing half 104 b for supportingand displaying a counter mechanism, as will be discussed in greaterdetail below. Housing 104 is formed of a suitable plastic material.

As seen in FIG. 4, handles 106 are secured to housing 104 by handlepivot posts 104 d extending from lower housing half 104 b and intorespective apertures 106 a formed in handles 106. Handle assembly 102includes a link member 122 pivotally connected to each handle 106 at apivot point 106 b formed in a respective handle 106. A distal end 122 aof each link member 122 is pivotally connected to a pivot point 140 aformed in a drive channel 140 via a drive pin 124. Each end of drive pin124 is slidably received in an elongate channel 104 e formed in arespective upper and lower housing half 104 a, 104 b. In use, as will bedescribed in greater detail below, as handles 106 are squeezed, linkmembers 122 push drive channel 140 distally via drive pin 124.

Channel assembly 108 includes a channel or cartridge cover 130 and anouter or lower channel 132 each having a proximal end retained inhousing assembly 102, between upper and lower housing halves 104 a, 104b. Cartridge cover 130 includes at least one retention element 130 aconfigured and adapted to selectively engage, in a snap-fit engagement,a complementary or corresponding retention element 132 a provided onouter channel 132.

As seen in FIGS. 4 and 6-12, clip applier 100 includes a clip pusher bar160 slidably disposed beneath cartridge cover 130. Pusher bar 160includes a distal end 160 a defining a pusher 160 c configured andadapted to selectively engage/move a distal-most clip “C1” stored insurgical clip applier 100. Pusher bar 160 further includes a proximalend 160 b defining a proximal window 160 d therein for slidablyreceiving drive pin 124 therein. Pusher bar 160 further defines a distalwindow 160 e therein for operative engagement with a stabilizer 162, aswill be discussed in greater detail below. Pusher bar 160 also includesa fin 160 f projecting from a side edge thereof and located in relativeclose proximity to proximal window 160 d.

Clip applier 100 further includes a stabilizer 162 configured to overlieand engage pusher bar 160. Stabilizer 162 includes a distal tab 162 aconfigured to engage distal window 160 e of pusher bar 160, an elongatewindow 162 b defined therein at a location to substantially overlie andbe in registration with proximal window 160 d formed in pusher bar 160.Stabilizer 162 further includes a nub 162 c extending from a bottomsurface thereof, at a location proximal of elongate window 162 b, whichis configured and dimensioned for receipt in a proximal-most aperture160 g formed in pusher bar 160. As seen in FIGS. 4 and 6, stabilizer 162further includes a pair of tabs 162 e extending from a top surfacethereof, at a proximal and a distal location, which are configured anddimensioned for receipt in respective channels formed in upper housinghalf 104 a.

As seen in FIGS. 4 and 4A-4C, clip applier 100 further includes a motionmultiplier system having a bell crank gear 154 pivotally supported inhousing 104 and an accelerator housing 156 slidably supported in housing104. Bell crank gear 154 includes a pivot pin 154 a configured forpivotable connection to housing 104, a disk-like body 154 b supported onpivot pin 154 a, an arm 154 c extending radially from disk-like body 154b, and a spur gear 154 d supported on pivot pin 154 a or integrallyformed therewith and located adjacent disk-like body 154 b. Bell crankgear 154 defines a detent or notch 154 e (see FIG. 24) formed in a sideedge of disk-like body 154 b and a longitudinally oriented slot 154 fformed in arm 154 c. Spur gear 154 d of bell crank gear 154 defines aplurality of gear teeth 154 g formed in a side edge thereof and may be asector gear as best shown in FIG. 4C.

Bell crank gear 154 is a common part for each of the small, medium andlarge scaled clip appliers 100. Notch 154 e formed in side edge ofdisk-like body 154 b of bell crank gear 154 is provided for the assemblyof the large scaled clip applier. The larger scaled clip applierrequires a greater pusher stroke and therefore a greater degree ofrotation of bell crank gear 154. Due to the greater rotation of bellcrank gear 154, disk-like body 154 b will contact a tab 156 e (see FIGS.4A and 4B) extending from an accelerator rack 156. During assembly, bellcrank gear 154 is rotated until notch 154 e contacts tab 156 e ofaccelerator rack 156.

With continued reference to FIGS. 4 and 4A-4C, accelerator rack 156 ofmotion multiplier system includes a base wall 156 a defining anelongate, longitudinally extending slot 156 b formed therein, forslidable receipt of pivot pin 154 a of bell crank gear 154. Acceleratorrack 156 includes a side wall 156 c projecting in opposite directionsfrom a side edge of base wall 156 a, and a gear rack 156 d formed inside wall 156 c and in registration or alignment with slot 156 b of basewall 156 a. Gear rack 156 d is configured for engagement with gear teeth154 g of spur gear 154 d of bell crank gear 154.

Clip applier 100 further includes a biasing member 158 interconnectingaccelerator rack 156 and drive channel 140.

As seen in FIG. 6, slot 154 f of arm 154 c of bell crank gear 154 isconfigured and dimensioned to slidably and rotatably receive a nub 162 dof stabilizer 162 therein. In use, as drive channel 140 is translateddistally, biasing member 158, which interconnects drive channel 140 andaccelerator rack 156, subsequently moves accelerator rack 156 distally.As accelerator rack 156 is moved distally, since nub 162 d of stabilizer162 rides in slot 154 f of arm 154 c of bell crank gear 154, acceleratorrack 156 causes bell crank gear 154 to rotate and push stabilizer 162and, in turn, pusher bar 160 distally.

Clip applier 100 further includes a clip carrier 170 disposed withinchannel assembly 108 and beneath pusher bar 160. Clip carrier 170 isgenerally a box-like structure having an upper wall 170 a, a pair ofside walls 170 b and a lower wall 170 c defining a channel 170 dtherethrough. Clip carrier 170 includes a plurality of spaced apartwindows 172 formed in upper wall 170 a and extending longitudinallyalong a length thereof. Clip carrier 170 includes an elongate window 170e (see FIG. 9) formed in lower wall 170 c and extending longitudinallyalong a length thereof.

As seen in FIGS. 4, 9 and 14, a stack of surgical clips “C” is loadedand/or retained within channel 170 d of clip carrier 170 in a manner soas to slide therewithin and/or therealong. Channel 170 d is configuredand dimensioned to slidably retain a stack or plurality of surgicalclips “C” in tip-to-tail fashion therewithin.

As seen in FIGS. 12 and 14, a distal end of clip carrier 170 includes apair of spaced apart, resilient tangs 171. Tangs 171 are configured andadapted to selectively engage a backspan of a distal-most surgical clip“C1” of the stack of surgical clips “C” retained within carrier 170.

As seen in FIGS. 4, 4F, 7 and 15, clip applier 100 further includes aclip follower 174 slidably disposed within channel 170 d of clip carrier170. As will be discussed in greater detail below, clip follower 174 ispositioned behind the stack of surgical clips “C” and is provided tourge the stack of clips “C” forward during an actuation of clip applier100. As will be described in greater detail below, clip follower 174 isactuated by the reciprocating forward and backward motion of wedge plate180.

As seen in FIGS. 4F and 7, clip follower 174 includes body portion 174 adefining a plane, a distal tab 175 extending substantially upwardly andrearwardly from body portion 174 a, and a proximal tab 176 extendingsubstantially downwardly and rearwardly from body portion 174 a. Distaltab 175 includes a distal portion 175 a extending downwardly below theplane defined by body portion 174 a and a proximal portion 175 bextending upwardly above the plane defined by body portion 174 a.

Proximal portion 175 b of distal tab 175 is configured and dimensionedto selectively engage windows 172 formed in upper wall 170 a of clipcarrier 170. In use, engagement of proximal portion 175 b of distal tab175 of clip follower 174 in a window 172 formed in upper wall 170 a ofclip carrier 170 prevents clip follower from traveling or moving in aproximal direction.

Proximal tab 176 is configured and dimensioned to selectively engagewindows 180 b formed in wedge plate 180. In use, engagement of proximaltab 176 of clip follower 174 in a window 180 b formed in wedge plate 180allows for clip follower 174 to be advanced or moved distally upon adistal movement of wedge plate 180.

As seen in FIGS. 4, 7-9, 16 and 17, clip applier 100 further includes awedge plate 180 slidably disposed within handle assembly 102 and channelassembly 108. Wedge plate 180 is positioned or disposed below clipcarrier 170. Wedge plate 180 includes a substantially tapered distal end180 a for selective operative interposition between jaws 120. Wedgeplate 180 defines a plurality of spaced apart windows or apertures 180 bextending longitudinally along a length thereof and formed in a raisedsection thereof, a distal window or aperture 180 c located distal ofapertures 180 b, and a proximal-most transversely oriented slot 180 dlocated proximal of aperture 180 c.

As seen in FIGS. 4, 8, 16 and 17, clip applier 100 includes a distallockout 178 supported by cartridge cover 130. Distal lockout 178includes a tail or tab 178 a extending substantially rearwardly anddownwardly and being configured and dimensioned for receipt in distalwindow or aperture 180 c of wedge plate 180.

As seen in FIGS. 4, 4D, 4E, 6, 11, 13, 18 and 20, clip applier 100includes a wedge plate motion reversing mechanism, in the form of apivot arm 179, pivotally supported in lower housing half 104 b ofhousing 104 for transmitting the translation of drive channel 140 to areverse translation of wedge plate 180. Pivot arm 179 includes a pivotboss 179 a configured for pivotable connection to housing 104, a firststem or finger 179 b provided at one end of pivot arm 179 and extendingin a direction opposite to pivot boss 179 a, and second stem or finger179 c provided at a second end of pivot arm 179 and extending in adirection opposite to pivot boss 179 a. First stem or finger 179 b isconfigured and adapted for engagement in proximal-most slot 180 d ofwedge plate 180. Second stem or finger 179 c is configured forengagement in a slot 140 g formed in drive channel 140 which isconnected in a window 140 g defined in a drive channel 140. Slot 140 gincludes a longitudinally extending distal portion and a longitudinallyextending proximal portion that are axially and transversely offset fromone another, and a transverse portion interconnecting the distal andproximal portions.

In use, as will be discussed in greater detail below, as drive channel140 is moved distally, after a dwell period (i.e., the length of thelongitudinally extending distal portion of slot 140 g of drive channel140), second stem or finger 179 c is moved in a distal direction,rotating pivot arm 179 and thereby moving first stem or finger 179 b ina second direction. As first stem or finger 179 b is moved in the seconddirection, first stem or finger 179 b pulls wedge plate 180 out frombetween jaws 120 urges against as well as urges or pushes proximallyagainst fin 160 f of pusher 160 to move pusher 160 in a proximaldirection so that pusher bar 160 c thereof is removed from between jaws120, and vice-versa. As wedge plate 180 is moved in a distal direction,as seen n FIG. 17, distal end 180 a of wedge plate 180 cams against aninner surface of jaws 120 to thereby maintain jaws 120 spaced apart fromone another.

As seen in FIGS. 4, 6-11, 13, 18 and 19, clip applier 100 includes adrive channel 140 reciprocally supported in and extending betweenhousing 104 of handle assembly 102 and channel assembly 108. A proximalend of drive channel 140 is supported between upper and lower housinghalves 104 a, 104 b of housing 104 and a distal end of drive channel 140is supported between cartridge cover 130 and outer channel 132 ofchannel assembly 108, at a location below wedge plate 180.

A distal end of drive channel 140 is a substantially U-shaped channelincluding a pair of spaced apart side walls 140 b extending from abackspan 140 c thereof, in a direction away from outer channel 132 andtoward cartridge cover 130. Drive channel 140 further defines a drivepin recess 140 a formed in backspan 140 c for pivotally receiving drivepin 124 therethrough. Drive channel 140 further defines a rib 140 eprojecting from backspan 140 c at a location distal of drive pin recess140 a. Drive channel 140 further defines a reciprocation limiting slot140 f formed in backspan 140 c at a location distal of slot 140 e.

As seen in FIGS. 4, 8, 9, 12, 14-16 and 19, clip applier 100 includes adrive channel strap 143 secured to drive channel 140. Strap 143 issecured to uprights 140 b of drive channel 140 so as to extendtransversely thereacross. Strap 143 is secured to drive channel 140 at alocation distal of reciprocation limiting slot 140 f. Strap 143 issecured to drive channel 140 such that wedge plate 180 extends beneathstrap 143 and above jaws 120.

As seen in FIGS. 4, 4G, 6, 10 and 21, clip applier 100 further includesan audible/tactile indicator 148 connected to drive channel 140 viadrive pin 124. Indicator 148 includes a resilient finger 148 a and apair of bosses 148 b. In use, as will be described in greater detailbelow, as clip applier 100 is actuated and drive channel 140 isreciprocated, first resilient finger 148 a of indicator 148 interactswith corresponding complementary structure or ledge 149 provided in clipapplier 100 to create an audible and/or a tactile feedback to the user.Bosses 148 b of indicator 148 ride within channel 104 e formed in upperhousing half 104 a and provide support to indicator 148 to preventindicator 148 from rotating.

As seen in FIGS. 4, 6, 10, 11, 13, 18 and 20, clip applier 100 furtherincludes a biasing member 146, in the form of a tension spring,operatively secured to and between a proximal end of drive channel 140and housing 104, tending to maintain drive channel 140 in a retracted orproximal-most position. Biasing member 146 functions to retract orfacilitate retraction of drive channel 140 following formation of a clip“C” positioned between jaws 120.

As seen in FIGS. 4, 4H, 11, 13, 18 and 20, a proximal end of drivechannel 140 includes a ratchet rack member 141 secured to drive pin 124and movable with drive channel 140. Ratchet rack member 141 isconfigured and adapted to engage with a ratchet pawl 142 supported inhousing 104. Rack member 141 and pawl 142 define a ratchet mechanism144. In use, as drive channel 140 is moved axially, rack member 141 isalso moved. Rack member 141 defines a series of rack teeth 141 a havinga length which allows pawl 142 to reverse and advance back over rackmember 141 when rack member 141 changes between proximal and distalmovement as drive channel 140 reaches a proximal-most or distal-mostposition.

Pawl 142 is pivotally connected to lower housing half 104 b by a pawlpin 147 at a location wherein pawl 142 is in substantial operativeengagement with rack member 141. Pawl 142 is engageable with rack member141 to restrict longitudinal movement of rack member 141 and, in turn,drive channel 140. Ratchet mechanism 144 further includes a pawl spring145 configured and positioned to bias pawl 142 into operative engagementwith rack member 141. Pawl spring 145 functions to maintain the teeth ofpawl 142 in engagement with the teeth 141 a of rack member 141, as wellas to maintain pawl 142 in a rotated or canted position.

As seen in FIGS. 1-4, 8, 10, 12, 14-17 and 19, clip applier 100 includesa pair of jaws 120 mounted on or at a distal end of channel assembly 108and actuatable by handles 106 of handle assembly 102. Jaws 120 areformed of a suitable biocompatible material such as, for example,stainless steel or titanium.

Jaws 120 are mounted in a distal end of drive channel 140 via a rivet122 or the like extending through reciprocation limiting slot 140 f ofdrive channel 140 such that jaws 120 are longitudinally stationaryrelative to outer channel 132 and drive channel 140. As seen in FIGS.12, 14, 17 and 19, jaws 120 define a channel 120 a therebetween forreceipt of a surgical clip “C1” therein.

As seen in FIGS. 1-4, 6, 11, 13 and 20, clip applier 100 furtherincludes a counter mechanism 190 supported in housing 104 of handleassembly 102. Counter mechanism 190 includes a display 192, a processor194, and an energy source 198 in the form of a battery or the like.Display 192 is a liquid crystal display that displays one or moreoperating parameters of clip applier 100 to the surgeon. The operatingparameter displayed may be an amount or number of remaining clips, anumber of clips that have been used, a position parameter, a surgicaltime of usage, or any other parameter of the procedure.

Counter mechanism 190 includes a tab 192 a, made from PVC, disposedbetween battery or energy source 198 and a contact 194 a of processor194 or between the contacts 194 a of processor 194 to prevent thebattery or energy source 198 from becoming drained during storage. Asseen in FIGS. 1A and 1B, tab 192 a extends out of housing 104 of clipapplier 100 in order to allow for easy removal of the tab therefrom.Once the tab 192 a is removed, battery or energy source 198 comes intoelectrical contact with the contact 194 a of processor 194 or betweenthe contacts 194 a of the processor 194.

Counter mechanism 190 is actuated by nub 140 e formed in drive channel140. In use, as seen in FIG. 36, as drive channel 140 is driven forward,nub 140 e thereof engages contact 194 a causing contact 194 a tocomplete a circuit and trigger processor 194 to perform a function(e.g., reduce the number appearing on display 192 by a give increment orvalue).

As seen in FIGS. 1A and 1C, clip applier 100 includes a shipping wedge200 supported on housing 104 and interposed between handles 106.Shipping wedge 200 functions to maintain handles 106 spaced apart orun-squeezed during a shipment and/or storage of clip applier 100.Shipping wedge 200 is connected to tab 192 a of counter mechanism 190,such that in order for an end user to use clip applier 100, the end usermust remove shipping wedge 200 thereby also removing tab 192 a toactivate counter mechanism 190.

As seen in FIGS. 1A and 1C, shipping wedge 200 includes a body portion202 in the form of a collar, defining a passage 204 configured anddimensioned for receipt of a portion of housing 104 therein. Shippingwedge 200 includes uprights 206 extending outwardly from opposed sidesof body portion 202 and being configured to receive handles 106 therein.Shipping wedge 200 further includes tabs 208 extending inwardly fromopposed sides of uprights 206. Tabs 208 of shipping wedge 200 areconfigured and dimensioned to engage with handles 106 when shippingwedge 200 is properly secured to clip applier 100.

With reference to FIGS. 22-53, the operation of the Covidien SURGICLIP™clip applier 100 is provided. Prior to any initial squeezing of handles106 of clip applier 100, as seen in FIGS. 22-24, drive pin 124 islocated at a proximal-most position, pawl 142 is located distal of rack140 d of drive channel 140, second finger 179 c of pivot arm 179 islocated at a distal-most position in the distal portion of window 140 gof drive channel 140 such that wedge plate 180 is located at adistal-most position, and no clips “C” are positioned within jaws 120.Since drive pin 124 is at a proximal-most position, pusher bar 160,stabilizer 162, and drive channel 140 are also at a proximal-mostposition.

With drive channel 140 and pusher bar 160 located at a proximal-mostposition, accelerator rack 156 is located at a proximal-most position,and second resilient finger 148 b of indicator 148 is disposed proximalof edge 149. Also, prior to an initial squeezing of handles 106 of clipapplier 100, with wedge plate 180 located at a distal-most position,distal end 180 a thereof is interposed between jaws 120.

Also prior to the initial squeeze, no clips “C” are present within jaws120. A clip “C” is first loaded into jaws 120 during the initialsqueezing of handles 106. As seen in FIGS. 25-33, during an initialsqueezing of handles 106, distal ends 122 a of link members 122 arecaused to be moved distally relative to housing 104. As distal ends 122a of link members 122 are moved distally, drive pin 124 is caused to bemoved distally thereby transmitting distal axial movement to drivechannel 140.

As drive channel 140 is moved distally, biasing member 158 is moveddistally therewith. As biasing member 158 is moved distally, biasingmember 158 drags accelerator rack 156 in a distal direction. Asaccelerator rack 156 is dragged in a distal direction, accelerator rack156 causes bell crank gear 154 to rotate about pivot pin 154 a andtransmit distal axial movement to nub 162 d of stabilizer 162 which, inturn, transmits distal axial movement to pusher bar 160. As drivechannel 140 is moved distally biasing member 146 is stretched orextended.

As seen in FIGS. 25, 32 and 33, during the initial squeeze of handles106, indicator 148 is moved distally along with the distal movement ofdrive channel 140. In use, indicator 148 functions to create an audibleclick and/or a tactile vibration, thereby indicating to the user thathandles 106 of surgical clip applier 100 have gone through at least aportion of a stroke. In particular, as seen in FIGS. 32 and 33, ashandles 106 are actuated, first resilient arm 148 a of audible/tactileindicator 148 rides over and/or along a ledge 149 formed in at least oneof upper and lower housing halves 104 a, 104 b and is flexed thereby. Asarm 148 a of audible/tactile indicator 148 reaches the proximal end ofledge 149, resilient arm 148 a snaps over the proximal end of ledge 149and comes into contact with a surface 149 a of ledge 149, therebycreating a first audible sound and a tactile vibration as resilient arm148 a comes into contact with surface 149 a of ledge 149. The firstindication of audible/tactile indicator 148 indicates to the user that aclip “C” has been appropriately loaded.

As seen in FIGS. 28 and 30, also during the initial squeeze of handles106, as pusher bar 160 is moved in a distal direction, pusher 160 cthereof engages a backspan of a distal-most clip “C1” and begins to moveor urge distal-most clip “C1” distally out of clip carrier 170 and intojaws 120. As distal-most clip “C1” is moved distally, tangs 171 of clipcarrier 170 are deflected or cammed out of engagement with distal-mostclip “C1” and return to their un-deflected or un-cammed state to capturea subsequent clip of the stack of clips “C”. During the initial squeezeof handles 106, pusher bar 160 is advanced an amount sufficient to placedistal-most clip “C1” in channels 120 a of jaws 120.

As seen in FIGS. 27 and 31, also during the initial squeeze of handles106, as drive channel 140 is moved in a distal direction, rack member141 of ratchet mechanism 144 is moved distally causing teeth 141 athereof to move into engagement with and over or across a tooth of pawl142. Once rack member 141 of ratchet mechanism 144 is moved intoengagement with pawl 142, drive channel 140 can not return to a home orproximal-most position until rack member 141 has cleared pawl 142.

During the initial squeeze of handles 106, as seen in FIGS. 25-33, drivechannel 140 is moved distally until finger 179 c of pivot arm 179 isengaged by the transverse portion of slot 140 g of drive channel 140(i.e., the dwell). Once the transverse portion of slot 140 g is inabutment with finger 179 c of pivot arm 179 (i.e., after the dwell hasbeen exhausted), further distal movement of drive channel 140 causesfinger 179 c to move and rotate pivot arm 179. Rotation of pivot arm 179causes movement of finger 179 b thereof which, in turn, causes wedgeplate 180 to be pulled in a proximal direction, thereby withdrawingdistal end 180 a thereof from between jaws 120 and allowing for jaws 120to eventually be closed or approximated, and pushes on fin 160 f ofpusher bar 160 to urge pusher bar 160 in a proximal direction such thatdistal end pusher member 160 c thereof is also moved from between jaws120 thus allowing for jaws 120 to eventually be closed or approximated.

Once the required rotation of pivot arm 179 is achieved, pivot arm 179stops rotating as finger 179 c of pivot arm 179 rides through theproximal portion of slot 140 g of drive channel 140. Finger 179 c ofpivot arm 179 remains in the proximal portion of slot 140 g of drivechannel 140 until the stroke of drive channel 140 is completed.

As seen in FIG. 38, as wedge plate 180 is moved in a proximal direction,wedge plate 180 is moved proximally relative to clip follower 174thereby moving windows 180 b thereof proximally relative to proximal tab176 of clip follower 174.

As seen in FIGS. 28 and 30, during the initial squeeze of handles 106,pusher bar 160 is moved distally with drive channel 140, as describedabove, until accelerator rack 156 abuts against a rib in lower body 104b of housing 104, at which time distal advancement of accelerator rack156 is stopped. With accelerator rack 156 prevented from further distaladvancement, as seen in FIG. 32, as drive channel 140 is furtheradvanced distally, drive channel 140 pulls or flexes resilient finger148 a of indicator 148 over a proximal end of ledge 149. In this manner,a first indication (i.e., audible and/or tactile) is created indicatingto a user that a surgical clip “C” has been appropriately loaded. Also,with accelerator rack 156 prevented from further distal advancement,bell crank 154 is prevented from rotating and thus pusher bar 160 isprevented from further distal advancement.

Referring now to FIGS. 34-40, during a further squeezing of handles 106,distal ends 122 a of link members 122 are caused to be moved furtherdistally relative to housing 104. As distal ends 122 a of link members122 are moved further distally, drive pin 124 is caused to be movedfurther distally thereby transmitting distal axial movement to drivechannel 140.

As seen in FIGS. 34-40, as drive channel 140 is moved further distally,pusher bar 160 is prevented from further distal advancement byaccelerator rack 156 abutting against the rib formed in the lower body104 b of housing 104. With accelerator rack 156 stopped from distaladvancement, further rotation of bell crank gear 154 is stopped, whichin turn stops distal advancement of stabilizer 160 and, in turn, stopsdistal advancement of pusher bar 160.

Additionally, as seen in FIG. 44, with distal end 180 a of wedge plate180 removed from between jaws 120, as drive channel 140 is moved furtherdistally, a distal edge of drive channel 140 and/or drive channel strap143 engages against camming surfaces 120 b of jaws 120 thus causing jaws120 to approximate toward one another and to form surgical clip “C1”interposed therebetween. Since drive channel strap 143 is fixed to drivechannel 140 and moves therewith, drive channel strap 143 functions tocap drive channel 140 so as to maintain jaws 120 within drive channel140 during the approximation of jaws 120 and to maintain wedge plate 180within drive channel 140 during operation of clip applier 100.

As seen in FIG. 45, surgical clip “C1” may be formed or crimped onto avessel “V” or any other biological tissue.

Drive channel 140 is permitted to move distally relative to pusher bar160 due to the translation of bosses 148 b of indicator 148 through slot160 d of pusher bar 160.

Also, as drive channel 140 is fully advanced distally, as seen in FIG.37, rack member 141 of ratchet mechanism 144 is moved distally to alocation beyond pawl 142 such that the teeth 141 a of rack member 141are moved distally of the tooth of pawl 142 thereby disengaging rackmember 141 and pawl 142 from one another. In this manner, drive channel140 is permitted or free to return to a home or proximal-most position.

As seen in FIGS. 32 and 33, as drive channel 140 is moved distally,resilient arm 148 a of audible/tactile indicator 148 snaps over thedistal end of ledge 149 and comes into contact with a surface 149 a ofledge 149, thereby creating an audible sound and/or a tactile vibration.Such audible sound and/or tactile vibration coincide with the loading ofsurgical clip “C”.

As seen in FIG. 43, as drive channel 140 is further moved distally,resilient arm 148 a of audible/tactile indicator 148 snaps over thedistal end of ledge 149 thereby creating a further audible sound and/ora tactile vibration. Such audible sound and/or tactile vibrationcoincide with the complete formation of surgical clip “C”.

With continued reference to FIG. 35-40, during the further squeezing ofhandles 106, with tab 192 a removed from counter mechanism 190, as drivechannel 140 is advanced distally, nub 140 e thereof engages contact 194a of processor 194 thereby completing a circuit and causing processor194 to perform a function, as described above.

Referring now to FIGS. 41-45, clip applier 100 is illustrated followinga complete stroke or squeezing of handles 106 and during an opening ofhandles 106. In this condition, drive channel 140 is at a distalposition, pusher bar 160 is at a distal position, wedge plate 180 is ata proximal position, accelerator 156 is spaced a distance from drivechannel 140, each biasing member 146 and 158 are stretched, and pawl 142is located proximal of rack 140 d.

As seen in FIGS. 46-52, during an opening or release of handles 106,distal ends 122 a of link members 122 are caused to be moved proximallyrelative to housing 104. As distal ends 122 a of link members 122 aremoved proximally, drive pin 124 is caused to be moved proximally therebytransmitting proximal axial movement to drive channel 140 and, in turn,pusher bar 160. The proximal movement of drive channel 140 isfacilitated by the constriction of biasing members 146. Alternatively,the release of handles 106 results in biasing member 146 withdrawingdrive channel 140 in a proximal direction.

As drive channel 140 is moved proximally, the distal edge of drivechannel 140 and/or drive channel strap 143 disengages from againstcamming surfaces 120 b of jaws 120 thus freeing jaws 120 for separationfrom one another for reinsertion of distal end 180 a of wedge plate 180therebetween, and to receive another surgical clip “C” therebetween. Inparticular, as drive channel 140 is moved proximally, the transverseportion of slot 140 g acts on finger 179 c to cause pivot arm 179 torotate and cause finger 179 b of pivot arm 179 to urge wedge plate 180distally. As wedge plate 180 is moved in a distal direction, as seen inFIGS. 51 and 52, distal end 180 a of wedge plate 180 is reinserted orreintroduced into jaws 120, thereby spreading jaws 120 apart.

As seen in FIGS. 49 and 50, as wedge plate 180 is moved distally,proximal tab 176 of clip follower 174 engages in a window 180 b of wedgeplate 180 and is thus urged distally a given distance. As clip follower174 is urged distally, stack of clips “C” is also urged distally. Asseen in FIG. 50, when wedge plate 180 reaches a distal-most position,clip channel 170 abuts, engages, urges or otherwise cams againstproximal portion 175 b of distal tab 175 until web 180 f of wedge plate180 rests substantially beneath distal portion 175 a of distal tab 175.In so doing, proximal portion 175 b of distal tab 175 is moved to extendinto an incrementally more distal window 172 of clip channel 170.

As seen in FIGS. 51 and 52, as clip follower 174 is urged forward,moving the stack of clips “C” forward, a distal-most clip “C1” movesdistal of pusher 160 c by camming beneath pusher 160 c of pusher bar 160until distal-most clip “C1” is caught by tangs 171 of clip applier 170.

Turning momentarily to FIG. 48, as drive channel 140 is moved in aproximal direction, arm 148 a of audible/tactile indicator 148 snapsback over ledge 149 and re-sets itself for the next firing stroke orsqueeze of handles 106.

As drive channel 140 is moved further in a proximal direction, drivechannel 140 engages against accelerator rack 156 causing acceleratorrack 156 to move in a proximal direction. Movement of accelerator rack156 in a proximal direction results in rotation of bell crank gear 154about pivot pin 152 a to thereby move pusher bar 160 in a proximaldirection. Additionally, as drive channel 140 is moved in a proximaldirection, nub 140 e thereof disengages contact 194 a of processor 194.

Turning now to FIG. 53, a distal end of clip applier 100 is illustratedfollowing a complete stroke or squeezing of handles 106 and after afinal clip has been expelled therefrom. Following firing of the lastclip, as seen in FIG. 53, proximal tab 176 of clip follower is disposedwithin a distal-most aperture or window of apertures 180 b of wedgeplate 180. In this manner, as wedge plate 180 is moved distallyfollowing a firing of a clip, in the manner described above, clipfollower 174 is also moved distally. Accordingly, as clip follower 174is moved distally, distal tab 175 thereof is moved distal of adistal-most window of windows 172 of clip carrier 170. In this manner,proximal portion 175 b of distal tab 175 engages against an innersurface of a top wall of clip carrier 170 and is cammed or urgeddownwardly.

As proximal portion 175 b of distal tab 175 is cammed or urgeddownwardly, distal portion 175 a of distal tab 175 engages against anupper surface of tab 178 a of lockout 178 and cams or urges tab 178 a oflockout 178 downwardly, across a path of strap 143, supported on drivechannel 140, and into distal window 180 c of wedge plate 180. In thismanner, if drive channel 140 is advanced distally, in the mannerdescribed above, strap 143 will abut against tab 178 a of lockout 178and prevent or block strap 143 and, in turn, drive channel 140 frommoving distally. At this stage, pawl 142 is located in a dwell, distalof rack 140 d, and handles 106 are arranged in a fully opened positionand are thus not capable of being opened any further. In thisconfiguration, clip applier is locked out and can no longer be used.

Depending on the size of the surgical clip, the size of components ofclip applier 100 will have to be scaled accordingly. The majority of thecomponents of the various sized clip appliers will be substantiallyidentical to one another. Components size relating to the width of theclips, such as the jaws 120 and the wedge plate 180, or components sizerelating to the length of the clip, such as the pusher bar 160, the bellcrank gear 154 and the pivot arm 179, are adjusted accordingly. In thismanner, each clip applier, of varying size, will be assembled insubstantially the same manner and the inner mechanism thereof willoperate in substantially the same manner.

For example, clip applier 100 may be provided in a relatively small,medium and large scale, wherein each of the sizes of clip appliersstores and fires a relatively small, medium or large surgical clip.Based on the relative dimensions of the surgical clips, thecorresponding clip appliers, and their corresponding components, must bescaled appropriately. However, in accordance with the presentdisclosure, each of the various sized clip appliers comprise the samecomponent and may be assembled in the same sequence as one another. Inthis manner, a technician assembling the clip appliers will only have tolearn the sequence and/or steps required for the assembly of one of thesizes of clip appliers and, in turn, be able to assemble the other sizesof clip appliers equally, without having to learn a new sequence or stepof assembly.

Accordingly, the assembly method and/or steps for a relatively small,medium or large clip applier are substantially identical to one another.

At least the following components or parts vary in shape based on therelative size or scale of the clip applier, namely, the length of thearms of pivot arm 179, the length of the slot in which accelerator rack156 translates; and the degree of rotation of bell crank gear 154.

Many other remaining components or parts are identical or have minorvariations in feature size or scale. However, if desired, the shapes ofthe following parts may be modified in order to achieve the same result,namely, the length of slot 154 f of bell crank gear 154, and/or thelength of slot 156 b formed in base wall 156 a of accelerator rack 156.

It is contemplated that for a relatively small scaled clip applier, thata given rotation of approximately 45°, for a relatively small scaledbell crank gear 154, will result in approximately a 0.345 inch axialdisplacement of a relatively small scaled pusher bar 160 in order toload a relatively small sized clip into jaws 120. Similarly, it iscontemplated that for a relatively medium scaled clip applier, that agiven rotation of approximately 70°, for a relatively medium scaled bellcrank gear 154, will result in approximately a 0.485 inch axialdisplacement of a relatively medium scaled pusher bar 160 in order toload a relatively medium sized clip into jaws 120. Likewise, it iscontemplated that for a relatively large scaled clip applier, that agiven rotation of approximately 90°, for a relatively large scaled bellcrank gear 154, will result in approximately a 0.710 inch axialdisplacement of a relatively large scaled pusher bar 160 in order toload a relatively large sized clip into jaws 120.

In an alternate embodiment, as seen in FIGS. 54-57, it is contemplatedthat a proximal end of drive channel 140 may include or define a ratchetrack 140 d integral therewith that is configured and adapted forengagement with ratchet pawl 142. Use and operation of ratchet mechanism244 is substantially identical to ratchet mechanism 144 and thus willnot be discussed in great detail herein.

In a further embodiment, as seen in FIG. 4 above, clip applier 100 maybe provided with a strap 196 configured to secure energy source 198 tohousing 104.

In an embodiment, it is also contemplated that as drive channel 140 ismoved distally, and as resilient arm 148 a of audible/tactile indicator148 snaps over the distal edge of ledge 149, resilient arm 148 a maystrike or contact a surface formed in housing 104 thereby amplifying thefurther or second audible sound and/or tactile vibration.

Turning now to FIGS. 58-69, a surgical clip applier, in accordance withan alternate embodiment of the present disclosure, is generallydesignated as 300. Surgical clip applier 300 is substantially identicalto surgical clip applier 100 and thus will only be discussed in detailherein to the extent necessary to identify differences in constructionand operation thereof.

As seen in FIGS. 58, 60 and 64-66, clip applier 300 includes motionmultiplier system having a bell crank gear 154, and an accelerator rack356 slidably supported in housing 104. Accelerator rack 356 includes abase wall 356 a defining an elongate, longitudinally extending slot 356b formed therein, for slidable receipt of pivot pin 154 a of bell crankgear 154. Accelerator rack 356 includes a side wall 356 c projecting inopposite directions from a side edge of base wall 356 a, and a gear rack356 d formed in side wall 356 c and in registration or alignment withslot 356 b of base wall 356 a. Gear rack 356 d is configured forengagement with gear teeth 154 g of spur gear 154 d of bell crank gear154. Accelerator rack 356 further includes a camming member 356 eprojecting from a distal edge of base wall 356 a, and a nub 356 fprojecting from distal edge of side wall 356 c.

The length of slot 356 b of base wall 356 a of accelerator rack 356 willvary depending on the size of clip applier 300. For relatively smallerclip appliers (e.g., clip appliers which apply relatively smallerclips), the length of slot 356 b of accelerator rack 356 will berelatively shorter, and for relatively larger clip appliers (e.g., clipappliers which apply relatively larger clips), the length of slot 356 bof accelerator rack 356 will be relatively longer.

In use, as will be discussed in great detail below, as accelerator rack356 is moved or translated axially, gear rack 356 d of accelerator rack356 engages with gear teeth 154 g of spur gear 154 d of bell crank gear154 to cause bell crank gear 154 to rotate or pivot about pivot pin 154a.

As seen in FIGS. 58, 61 and 67-69, clip applier 300 includes a motionreversing mechanism having a wedge plate pivot arm 379 pivotallysupported in lower housing half 104 b of housing 104 for transmittingtranslation of wedge plate 180 to translation of drive channel 140.Pivot arm 379 includes a pivot boss 379 a configured for pivotableconnection to housing 104, a first stem or finger 379 b provided at oneend of pivot arm 379 and extending in a direction opposite to pivot boss379 a, and second stem or finger 379 c provided at a second end of pivotarm 379 and extending in a same direction as pivot boss 379 a. Firststem or finger 379 b is configured and adapted for engagement inproximal-most slot 180 d of wedge plate 180. Second stem or finger 379 cis configured for engagement in a slot 358 b formed in arm link 358(FIG. 62) which is connected in a window 140 h defined in a drivechannel 140.

In use, as will be discussed in greater detail below, as drive channel140 is moved distally, after a dwell period, arm link 358 urges secondstem or finger 379 c of pivot arm 379 to move in a first or distaldirection thereby moving first stem or finger 379 b in a second orproximal direction and causing wedge plate 180 to move in the seconddirection, and vice-versa. As wedge plate 180 is moved in a distaldirection, as will be discussed hereinbelow, wedge plate 180 camsagainst an inner surface of jaws 120 to thereby maintain jaws 120 spacedapart from one another.

Clip applier 300 further includes a biasing member 384, in the form of atension spring, operatively secured to and between a proximal end ofwedge plate 180 and housing 104, tending to maintain wedge plate 180 inan advanced or distal-most position. Biasing member 384 functions toadvance or facilitate advancement of wedge plate 180 following formationof a clip “C” positioned between jaws 120.

As seen in FIGS. 58, 59 and 64-66, clip applier 300 further includes anaudible/tactile indicator 348 supported on drive channel 140. Indicator348 includes a first resilient finger 348 a and second resilient finger348 b. In use, as will be described in greater detail below, as clipapplier 300 is actuated and drive channel 140 is reciprocated, firstresilient finger 348 a of indicator 348 interacts with correspondingcomplementary structure provided in clip applier 300 to create anaudible and/or a tactile feedback to the user and second resilientfinger 348 b of indicator 348 interacts with camming member 356 e ofaccelerator rack 356 to adjust the stroke of clip applier 300 forvarying sizes of clip applier 300.

As seen in FIGS. 58, 62 and 67-69, clip applier 300 further includes anarm link 358 slidably disposed in housing 104 and operatively connectedto drive channel 140 for translation therewith. Arm link 358 includes abody portion 358 a defining a slot 358 b therein, a guide wall 358 cprojecting from an upper surface of body portion 358 a, and a stem 358 dextending in an upward direction from a proximal edge of body portion358 a. Slot 358 b of arm link 358 is configured to slidably receivesecond stem or finger 379 c of pivot arm 379. Guide wall 358 c of armlink 358 is dimensioned to ride against a surface of drive channel 140.Stem 358 d of arm link 358 is dimensioned for slidable receipt in window140 h formed in drive channel 140. Window 140 h of drive channel 140 isdimensioned to define a period of dwell between when drive channel 140is moved distally and when arm link 358 actuates pivot arm 379.

With reference to FIGS. 64-69, the differences in the operation ofsurgical clip applier 300, as compared to surgical clip applier 100, aredescribed. Prior to any initial squeezing of handles 106 of clip applier300, as seen in FIGS. 64 and 67, drive pin 124 is located at aproximal-most position, pawl 142 is located distal of rack 140 d ofdrive channel 140, arm link 358 is located at a proximal-most positionrelative to housing 104 and a distal-most position in window 140 h ofdrive channel 140, and no clips “C” are positioned within jaws 106.Since drive pin 124 is at a proximal-most position, pusher bar 160,stabilizer 162, and drive channel 140 are also at a proximal-mostposition. With pusher bar 160 located at a proximal-most position,accelerator rack 356 is located at a proximal-most position, and secondresilient finger 348 b of indicator 348 is disposed proximal of cammingmember 356 e of accelerator rack 356. Also, prior to an initialsqueezing of handles 106 of clip applier 300, wedge plate 180 is locatedat a distal-most position such that distal end 180 a of wedge plate 180is interposed between jaws 120.

As drive channel 140 is moved distally, as seen in FIGS. 65 and 68,indicator 348 is moved distally therewith. As indicator 348 is moveddistally, second resilient finger 348 b thereof drags accelerator rack356 in a distal direction. As accelerator rack 356 is dragged in adistal direction, accelerator rack 356 causes bell crank gear 154 torotate about pivot pin 154 a and transmit distal axial movement to nub162 c of stabilizer 162 which, in turn, transmits distal axial movementto pusher bar 160. As drive channel 140 is moved distally biasing member146 is stretched or extended.

During the initial squeeze of handles 106, as seen in FIGS. 67 and 68,drive channel 140 is moved distally until stem 358 d of arm link 358 isengaged by an end wall of window 140 h of drive channel 140 (i.e., thedwell). Once the end wall of window 140 h is in abutment with stem 358 dof arm link 358 (i.e., after the dwell has been exhausted), furtherdistal movement of drive channel 140, as seen in FIG. 69, results indistal movement of arm link 358. As arm link 358 is moved distally, thetransverse portion of slot 358 b of arm link 358 will cause pivot arm379 to rotate which, in turn, causes wedge plate 380 to move in aproximal direction, thereby withdrawing distal end 180 a thereof frombetween jaws 120 and allowing for jaws 120 to eventually be closed orapproximated. Once the required rotation of pivot arm 379 is achieved,pivot arm 379 stops rotating as finger 379 c of pivot arm 379 ridesthrough longitudinal portion of L-shaped slot 358 b of arm link 358.Finger 379 c of pivot arm 379 remains in longitudinal portion ofL-shaped slot 358 b of arm link 358 until the stroke of drive channel140 is completed.

As seen in FIGS. 64 and 65, during the initial squeeze of handles 106,pusher bar 160 is moved distally with drive channel 140, as describedabove, until nub 356 f of accelerator rack 356 abuts against a ledgeformed in housing 104, at which time distal advancement of acceleratorrack 356 is stopped. With accelerator rack 356 prevented from furtherdistal advancement, as seen in FIG. 66, as drive channel 140 is furtheradvanced distally, drive channel 140 pulls or flexes second resilientfinger 348 b of indicator 348 from behind camming member 356 e ofaccelerator rack 356 allowing pusher bar 160 to move in a proximaldirection to a home position. Pusher bar 160 is retracted to its homeposition by a return spring 359 having a first end that is secured topusher bar 160 and a second end that is secured to the housing.

Following a complete stroke or squeezing of handles 106 and during anopening of handles 106, drive channel 140 is moved in a proximaldirection. In operation, as drive channel 140 is moved proximally, afront end wall of window 140 h of drive channel 140 acts on stem 358 dof arm link 358 to drawn arm link 358 in a proximal direction. As armlink 358 is moved proximally, arm link 358 causes pivot arm 379 torotate which, in turn, causes wedge plate 180 to move in a distaldirection. As wedge plate 180 is moved in a distal direction, distal end180 a of wedge plate 180 is reinserted or reintroduced into jaws 120,thereby spreading jaws 120 apart.

As drive channel 140 is moved further in a proximal direction, secondresilient finger 348 b of indicator 348 engages against camming member356 e of accelerator rack 356 causing accelerator rack 356 to move in aproximal direction. Movement of accelerator rack 356 in a proximaldirection results in rotation of bell crank gear 152 about pivot pin 152a to thereby move pusher bar 160 and stabilizer 162 in a proximaldirection. As drive channel 140 is further moved in a proximaldirection, second resilient finger 348 b of indicator 348 cams, flexesor snaps behind camming member 356 e for re-engagement with acceleratorrack 356.

Turning now to FIGS. 70-88, a surgical clip applier, in accordance withan alternate embodiment of the present disclosure, is generallydesignated as 400. Surgical clip applier 400 is substantially identicalto surgical clip applier 100 and thus will only be discussed in detailherein to the extent necessary to identify differences in constructionand operation thereof.

As seen in FIGS. 70, 71 and 75-77, clip applier 400 includes motionmultiplier system having a gear member 454 rotatably supported inhousing 404 of handle assembly 402. Gear member 454 includes a bodyplate 454 a defining an axis of rotation, a gear 454 b supported on bodyplate 454 a and concentric with the axis of rotation, and a gear segment454 c formed at an outer edge of body plate 454 a.

As seen in FIGS. 70, 72 and 75-77, clip applier 400 further includes adrive channel gear rack 442 supported on or otherwise connected to drivechannel 440. Drive channel gear rack 442 defines a plurality of gearteeth 442 a formed in a side edge thereof. Drive channel gear rack 442is configured and dimensioned such that gear teeth 442 a thereof areengageable with gear 454 b of gear member 454. In use, as drive channel440 is translated, drive channel gear rack 442 is translated therewithor vice-versa.

As seen in FIGS. 70, 73 and 75-77, the motion multiplier system of clipapplier 400 also includes a pusher bar gear rack 462 supported on orotherwise connected to pusher bar 460. Pusher bar gear rack 462 definesa plurality of teeth 462 a formed in a side edge thereof, and a stem 462b extending proximally therefrom. Pusher bar rack 462 is configured anddimensioned such that gear teeth 462 a thereof are engageable with gearsegment 454 c of gear member 454. In use, as pusher bar 460 istranslated, pusher bar gear rack 462 is translated therewith orvice-versa.

As seen in FIGS. 70, 74 and 75, clip applier 400 includes a pusher bar460 having a resilient finger 460 c projecting from a surface thereof.When handle assembly 404 is in an un-squeezed condition, as seen in FIG.75, resilient finger 460 c of pusher bar 460 is disposed distally of adrive block 440 a (FIGS. 75-77) extending from drive channel 440. Also,in the initial un-squeezed condition, no clips “C” are positioned withinjaws 106.

With reference to FIGS. 75-86, the differences in the operation ofsurgical clip applier 400, as compared to surgical clip applier 100, aredescribed. Prior to any initial squeezing of handles 106 of clip applier400, as seen in FIGS. 75-77, drive pin 124 is located at a proximal-mostposition, pawl 142 is located distal of rack 140 d of drive channel 440,each of drive channel gear rack 442 and pusher gear rack 462 are locatedat a proximal-most position relative to housing 104 and gear member 454is un-rotated. Since drive pin 124 is at a proximal-most position, drivebar 440 and pusher bar 460 are each also located at a proximal-mostposition. Also, prior to an initial squeezing of handles 106 of clipapplier 400, drive block 440 a of drive channel 440 is disposedproximally of resilient finger 460 c pusher bar 460.

As drive channel 440 is moved distally, as seen in FIGS. 78 and 79,drive channel 440 is moved distally. As such, drive block 440 a of drivechannel 440 engages resilient finger 460 c of pusher bar 460 therebycausing pusher bar 460 to be advanced distally as well. As drive channel440 and pusher bar 460 are moved distally, pusher bar 460 moves pushergear rack 462 until teeth 462 a of pusher gear rack 462 engages gearsegment 454 c of gear member 454.

Turning now to FIGS. 80-82, as handle 106 are further actuated, thusmoving drive channel 440 further distally, pusher bar 460 is moveddistally an amount sufficient for pusher gear rack 462 to be moveddistal and free of gear segment 454 c of gear member 454. Also, at thispoint in time teeth 442 a of drive channel gear rack 442 engage withgear 454 b of gear member 454, thus preventing gear member 454 fromreturning to a home position.

At this stage, a clip (not shown) has been fully delivered into the jawsby pusher bar 460. Additionally, at this stage pawl 142 has been engagedby rack 140 d of drive channel 440. As such, drive channel 440 may notreturn to a home position until drive channel 440 has completed itsdistal stroke.

As seen in FIGS. 83 and 84, as drive channel 440 is further moveddistally, drive block 440 a of drive channel 440 snaps beyond resilientfinger 460 c of pusher bar 460 thereby allowing extension spring 464 towithdraw pusher bar 460 to a home position.

As seen in FIGS. 85 and 86, while pusher bar 460 remains static in thehome position, drive channel 440 may continue to move distally to fullyactuate clip applier 400 and form the surgical clip disposed within thejaws. At this stage, rack 140 d of drive channel 440 has moved distallybeyond pawl 142 thus allowing for drive channel 440 to return to thehome position.

Assembly of each of the various sized clip appliers 100-400 isaccomplished in substantially the same sequence of steps irrespective ofthe relative size of the clip applier. In this manner, as stated above,a technician assembling the clip appliers will only have to learn thesequence and/or steps required for the assembly of one of the sizes ofclip appliers and, in turn, be able to assemble the other sizes of clipappliers equally, without having to learn a new sequence or step ofassembly.

Turning now to FIGS. 87-110, an exemplary method of assembling arelatively small, medium and/or large clip applier 100 is illustrated.As seen in FIGS. 87 and 88, during assembly, a lower housing half 104 bis provided and a battery or energy source 198 is seated within lowerhousing half 104 b. Additionally, a processor 192, including a tab 192b, is seated within window 104 c of lower housing half 104 b such thattab 192 b extends outwardly of lower housing half 104 b. Either prior toor following placement of processor 192 and battery 198 in lower housinghalf 104 b, pawl spring 145 and pawl pin 147 are secured or insertedinto lower housing half 104 b, and pawl 142 is inserted over pawl pin147 and moved into engagement with pawl spring 145.

As seen in FIGS. 91 and 92, a correspondingly sized pivot arm 179 (e.g.,a pivot arm 179 corresponding in size to a length and/or width of thesurgical clips) is pivotally attached or seated into lower housing half104 b via pivot boss 179 a. Additionally, as seen in FIGS. 91 and 92,rack member 141 is slidably positioned within lower housing half 104 bsuch that teeth 141 a of rack member 141 are operatively associated withthe teeth of pawl 142. Additionally, a distal opening 141 b of rackmember 141 overlies elongate channel 104 e defined in lower housing half104 b, and a projection 141 c of rack member 141 is slidably positionedwithin a complementary slot defined by lower housing half 104 b.

Turning now to FIGS. 93 and 94, a channel assembly 108 is connected tolower housing half 104 b. Channel assembly 108 includes a lower channel132, a drive channel 140 slidably disposed within lower channel 132,jaws 120 fixedly connected to lower channel 132, and channel strap 143secured near a distal end of drive channel 140. When channel assembly108 is connected to lower housing half 104 b, drive pin recess 140 a isaligned with opening 141 b of rack member 141. Also, second finger 179 cof pivot arm 179 is slidably disposed within window 140 g of drivechannel 140.

As seen in FIGS. 93 and 94, a correspondingly sized wedge plate 180(e.g., a wedge plate 180 corresponding in size to a length and/or widthof the surgical clips) is slidably positioned over drive channel 140such that a distal end 180 a of wedge plate 180 is interposed betweenchannel strap 143 and jaws 120, and a proximal end of wedge plate 180 isconnected to first finger 179 b of pivot arm 179.

Additionally, as seen in FIGS. 93 and 94, biasing member 146 is providedand has a first end connected to drive channel 140 and a second endsecured to lower housing half 104 b.

Turning now to FIGS. 95 and 96, an accelerator rack 156 is slidablypositioned within lower housing half 104 b, and a correspondingly sizedbell crank gear 154 (e.g., a bell crank gear 154 corresponding in sizeto a length and/or width of the surgical clips) pivotally connected tolower housing half 104 b via pivot pin 154 a, wherein the pivot pin 154a extends through accelerator rack 156. When properly positioned spurgear 154 d of bell crank gear 154 engages gear rack 156 d of acceleratorrack 156. (see FIGS. 4A-4C). A biasing member 158 is provided andinterconnected between drive channel 140 and accelerator rack 156.

Next, as seen in FIGS. 97 and 98, a pair of handles 106 is connected tolower housing half 104 b. In particular, a distal aperture 106 a of eachhandle 106 is pivotally disposed on a respective pivot post 104 d oflower housing half 104 b. Also, link members 122 are provided which arepivotally connected to a respective handle 106 and extend therefrom suchthat a distal end 122 a thereof overlies pivot point 140 a of drivechannel 140.

Turning now to FIGS. 99 and 100, either prior to, during or followingthe preceding steps, a stack of clips “C” is inserted into a channel 170d of a clip carrier 170. Also, a clip follower 174 is placed withinchannel 170 d of clip carrier 170 at a location proximal of the stack ofclips “C.” In an embodiment, twenty-two clips “C” may be loaded intoclip carrier 170. Depending on the size clips “C” (e.g., width and/orlength) to be loaded in the clip carrier 170, a correspondingly sizedclip carrier 170 and clip follower 174 is provided or selected.

As seen in FIGS. 101 and 102, a correspondingly sized pusher bar 160(e.g., a pusher bar 160 corresponding in size to a length and/or widthof the surgical clips) is slidably disposed in cartridge cover 130, andthe loaded clip carrier 170 is fixedly placed within cartridge cover 130so as to cover a distal end of pusher bar 160.

Turning now to FIGS. 103 and 104, a lockout 178 is secured near a distalend of cartridge cover 130. In particular, a tab 178 a of lockout 178 isoriented to extend in a proximal direction. Also as seen in FIGS. 103and 104, a stabilizer 162 is connected to a proximal end of pusher bar160. In particular, a distal tab 162 a of stabilizer 162 is insertedinto a distal window 160 e of pusher bar 160, and an elongate window 162b of stabilizer 162 is aligned with a proximal window 160 d of pusherbar 160. As seen in FIGS. 103 and 104, nub 162 d of stabilizer 162extends through pusher bar 160.

Turning now to FIGS. 105 and 106, with pusher bar 160 a clip carrier 170connected to cartridge cover 130, cartridge cover 130 is connected toouter channel 132 such that the proximal end of pusher bar 160 overlieslower housing half 104 b. In particular, proximal window 160 d of pusherbar 160 is positioned over distal end 122 a of link members 122 and overpivot point 140 a of drive channel 140. When pusher bar 160 ispositioned within lower housing half 104 b, nub 162 d of stabilizer 162is positioned within slot 154 f of arm 154 c of bell crank gear 154.(see FIG. 4C).

As seen in FIGS. 107 and 108, a drive pin 124 is inserted throughproximal window 160 d of pusher bar 160, through each distal end 122 aof link members 122, through pivot point 140 a of drive channel 140 (seeFIGS. 97 and 98), through opening 141 b of rack member 141 (see FIGS. 91and 92), and into elongate channel 104 e defined in lower housing half104 b (see FIGS. 91 and 92).

With continued reference to FIGS. 107 and 108, an audible/tactileindicator 148 is connected to drive pin 124 so as to move therewith.Next, upper housing half 104 a is secured to lower housing half 104 b.

As seen in FIGS. 109 and 110, a shipping wedge 200 is introduced betweenhandles 106 and connected to housing 104. Additionally, a distal or freeend of tab 192 b is connected to shipping wedge 200 such that uponremoval of shipping wedge 200 from housing 104 results in removal of tab192 b and activation of the counter mechanism.

It should be understood that the foregoing description is onlyillustrative of the present disclosure. Various alternatives andmodifications can be devised by those skilled in the art withoutdeparting from the disclosure. Accordingly, the present disclosure isintended to embrace all such alternatives, modifications and variances.The embodiments described with reference to the attached drawing figuresare presented only to demonstrate certain examples of the disclosure.Other elements, steps, methods and techniques that are insubstantiallydifferent from those described above and/or in the appended claims arealso intended to be within the scope of the disclosure.

What is claimed is:
 1. A surgical clip applier, comprising: a housing;at least one handle pivotably connected to the housing; a channelassembly extending distally from the housing; a pair of jaws supportedon and extending from a distal end of the channel assembly, wherein thepair of jaws are adapted to accommodate a clip therein and operable toeffect formation of a clip in response to movement of said handles; aclip carrier disposed within said channel assembly and defining achannel and a plurality of windows therein; a plurality of clipsslidably disposed within said channel of said clip carrier; a clippusher bar reciprocally positioned within at least one of said housingand said channel assembly, said pusher bar having a first endoperatively connected to at least one of said handles and a second enddefining a pusher, said pusher bar being movable towards said jaws assaid handles are approximated in a first direction by an initial amountin order to move a distal-most clip between said jaws, and said pusherbar being configured and adapted to move towards said housing as saidhandles are approximated an additional amount in said first direction tomove said pusher behind a distal-most clip in said plurality of clips; awedge plate reciprocally disposed within said channel assembly, whereina distal end of the wedge plate is selectively positionable between thepair of jaws to maintain the pair of jaws spaced apart, said wedge platebeing operatively connected to said at least one handle and including aplurality of apertures formed along a length thereof; and a clipfollower slidably disposed within said channel of said clip carrier anddisposed proximally of said plurality of clips, said clip follower beingconfigured and adapted for selective engagement with said windows ofsaid clip carrier and said apertures of said wedge plate, wherein saidclip follower is configured and adapted to urge said plurality of clips,in a distal direction relative to said clip carrier, upon reciprocalmovement of said wedge plate.
 2. The clip applier according to claim 1,wherein the clip follower is configured to engage the wedge plate andmove distally upon distal translation of the wedge plate, and isconfigured to engage the clip carrier and stop proximal movement thereofupon proximal translation of the wedge plate.
 3. The clip applieraccording to claim 1, further comprising a motion multiplier systemconfigured to distally move the pusher bar by an incremental amount uponan initial actuation of the handles, and configured to proximally movethe pusher bar and the wedge plate subsequent to the initial actuationof the handles.
 4. The clip applier according to claim 1, furthercomprising a drive channel translatably slidably disposed within atleast one of said housing and said channel assembly, said drive channelhaving a first end operatively connected to said at least one handle anda second end configured and dimensioned to selectively engage said pairof jaws to effectuate closure of said pair of jaws, said drive channelbeing moved towards said pair of jaws as said at least one handle ismoved actuated in a first direction to move said second end thereofagainst said jaws to close said jaws, said drive channel being movedaway from said jaws as said at least one handle is moved a second amountto move said second end thereof away from said jaws to allow said jawsto open.
 5. The clip applier according to claim 4, further comprising amotion reversing mechanism operatively connected to said wedge plate andsaid drive channel, wherein rotation of said motion reversing mechanism,during distal movement of said drive channel, results in proximalmovement of said wedge plate.
 6. The clip applier according to claim 4,further comprising a motion multiplier system including: a bell crankgear pivotally supported in the housing and pivotally connected to thepusher bar; an accelerator rack slidably supported in the housing andoperatively joined to the bell crank gear; and a biasing memberinterconnecting the drive channel and the accelerator rack, wherein adistal translation of the drive channel causes distal translation of theaccelerator rack via the biasing member, and wherein distal translationof the accelerator rack causes a first rotation of the bell crank gearand distal translation of the pusher bar.
 7. The clip applier accordingto claim 6, wherein the bell crank gear includes an arm extendingradially therefrom and an elongate slot formed in the arm, wherein theelongate slot slidably receives a boss operatively associated with thepusher bar.
 8. The clip applier according to claim 6, further comprisinga motion reversing mechanism operatively connected to said drive channeland said wedge plate and selectively engageable with said pusher bar,wherein rotation of said motion reversing mechanism, during said distaltranslation of said drive channel, results in proximal movement of saidwedge plate and said pusher bar.
 9. The clip applier according to claim4, further comprising a ratchet mechanism including: a rack, having aplurality of ratchet teeth, associated with said drive channel; and apawl, having at least one tooth, disposed at a location to selectivelyengage said rack, wherein said pawl is biased into engagement with saidrack, wherein as said drive channel is longitudinally reciprocated, saidplurality of teeth are passed over said pawl, and wherein said pawlprevents inadvertent return of said drive channel before full actuationof said at least one handle.
 10. The clip applier according to claim 4,further comprising a lockout disposed in a distal end of said channelassembly, wherein said lockout is urged by said clip follower to extendacross a path of said drive channel, thereby preventing said drivechannel from moving distally.
 11. The clip applier according to claim 4,wherein said drive channel is configured and dimensioned to at leastpartially surround said jaws and said wedge plate, wherein said drivechannel includes a strap extending across a distal end thereof formaintaining said jaws and said wedge plate within said drive channel.12. The clip applier according to claim 1, further comprising a lockoutdisposed in a distal end of said channel assembly.
 13. The clip applieraccording to claim 12, wherein said lockout is actuated by said clipfollower when a last clip is expelled from said clip applier.
 14. Theclip applier according to claim 1, further comprising a counter displaymechanism supported in at least one of said housing and said channelassembly, wherein said counter display mechanism is configured andadapted to display a change in status of said clip applier upon eachactuation of said at least one handle.
 15. A surgical clip applier,comprising: a housing; at least one handle pivotably connected toopposite sides of the housing; a channel assembly fixed to and extendingfrom the housing; a pair of jaws supported on and extending from adistal end of the channel assembly; a clip carrier disposed within saidchannel assembly and defining a channel; a plurality of clips slidablydisposed within said channel of said clip carrier; a clip followerslidably disposed within said channel of said clip carrier at a locationproximal of said plurality of clips; a drive channel translatablydisposed within at least one of said housing and said channel assembly,said drive channel having a first end operatively connected to at leastone of said handles and a second end configured and dimensioned toselectively engage said pair of jaws to effectuate closure thereof; apusher bar translatably disposed within at least one of said housing andsaid channel assembly, said pusher bar being connected to said drivechannel via a motion multiplier system, a distal end of said pusher barbeing configured to engage a distal-most clip of the plurality of clips;a wedge plate reciprocally disposed within at least one of said housingand said channel assembly, wherein a distal end of said wedge plate isselectively insertable between said pair of jaws; and a motion reversingmechanism including a first end connected to said drive channel, and asecond end connected to said wedge plate and engageable by said pusherbar, wherein distal translation of said drive channel causes said pusherbar to translate distally via said motion multiplier system; and whereindistal translation of said drive channel causes said pusher bar and saidwedge plate to translate proximally, via said motion reversingmechanism, following a dwell period.
 16. The clip applier according toclaim 15, further comprising a lockout disposed in a distal end of saidchannel assembly, wherein said lockout is actuated by said clip followerwhen a last clip is expelled from said clip applier, wherein saidlockout is urged by said clip follower to extend across a path of saiddrive channel, thereby preventing said drive channel from movingdistally.
 17. The clip applier according to claim 16, wherein said wedgeplate defines a plurality of apertures formed along a length thereof,wherein said clip carrier defines a plurality of windows formed along alength thereof, wherein said clip follower is configured and adapted forselective engagement with said windows of said clip carrier and saidapertures of said wedge plate, wherein said clip follower is configuredand adapted to distally incrementally urge said plurality of clipsrelative to said clip carrier upon a distal advancement of said wedgeplate.
 18. The clip applier according to claim 17, wherein said pair ofjaws are adapted to accommodate a clip therein and are operable toeffect formation of a clip in response to distal translation of saiddrive channel.
 19. The clip applier according to claim 18, furthercomprising an indicator configured to create at least one of an audibleindication and a tactile indication upon at least one of a loading of aclip into said pair of jaws and a formation of a clip by said pair ofjaws.
 20. The clip applier according to claim 15, wherein the motionmultiplier system includes a bell crank gear having an arm extendingradially therefrom and an elongate slot formed in the arm, wherein theelongate slot slidably receives a boss operatively associated with thepusher bar.
 21. The clip applier according to claim 20, wherein themotion multiplier system includes an accelerator rack having a series ofteeth and the bell crank gear includes a series of teeth engaged withthe teeth of the accelerator rack, wherein axial translation of theaccelerator rack results in rotation of the bell crank gear and axialtranslation of the pusher bar.
 22. The clip applier according to claim21, wherein the accelerator rack is connected to the drive channel via abiasing member.
 23. The clip applier according to claim 15, furthercomprising a ratchet mechanism including: a rack, having a plurality ofratchet teeth, associated with said drive channel; and a pawl, having atleast one tooth, disposed at a location to selectively engage said rack,wherein said pawl is biased into engagement with said rack, wherein assaid drive channel is longitudinally reciprocated, said plurality ofteeth are passed over said pawl, and wherein said pawl preventsinadvertent return of said drive channel before full actuation of saidat least one handle.
 24. The clip applier according to claim 15, whereinsaid drive channel is configured and dimensioned to at least partiallysurround said jaws and said wedge plate, wherein said drive channelincludes a strap extending across a distal end thereof for maintainingsaid jaws and said wedge plate within said drive channel.
 25. The clipapplier according to claim 15, further comprising a counter mechanism,wherein the counter mechanism is actuatable upon one firing sequence ofthe clip applier, and wherein the counter mechanism provides anindication that one less clip is present in the clip applier.
 26. Asurgical clip applier mechanism operable to deliver at least relativelysmall, medium and large surgical clips, the surgical clip appliermechanism comprising: a drive channel capable of translatable movement;a pair of jaws engageable by a distal end of the drive channel, whereinthe pair of jaws are approximated upon distal translation of the drivechannel; a wedge plate capable of reciprocal translation relative to thedrive channel, wherein a distal end of the wedge plate is selectivelypositionable between the pair of jaws, the wedge plate defining aplurality of apertures formed along a length thereof; a clip carrierfixedly located with respect to the drive channel, the clip carrierdefining a channel and a plurality of windows formed along a lengththereof; a plurality of clips slidably disposed within said channel ofsaid clip carrier; a clip follower slidably disposed within said channelof said clip carrier at a location proximal of said plurality of clips;a pusher bar capable of reciprocal translation relative to the drivechannel, wherein a distal end of the pusher bar is configured forengagement with a distal-most clip of the plurality of clips; a motionmultiplier system including a bell crank gear and an accelerator rack,the accelerator rack being coupled to the drive channel via a biasingmember, the bell crank gear being coupled to the accelerator rack viacomplementary gear teeth, and the bell crank gear being coupled to thepusher bar, wherein distal translation of the drive channel causes theaccelerator rack to translate distally, causing the bell crank gear torotate, causing the pusher bar to translate distally; and a motionreversing mechanism including a first end connected to the drivechannel, and a second end connected to the wedge plate and engageable bythe pusher bar, wherein distal translation of the drive channel causesthe first end of the pivot arm to translate distally, causing the secondend of the pivot arm to translate in a proximal direction, thus causingthe wedge plate to translate in a proximal direction; and wherein distaltranslation of the pusher bar is stopped upon contact of the pusher barwith the second end of the motion reversing mechanism.